Healthcare Provider Details

I. General information

NPI: 1679514350
Provider Name (Legal Business Name): JERILYNN LEA HULTMAN O.T.
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 06/10/2006
Last Update Date: 11/06/2023
Certification Date: 11/06/2023
Deactivation Date:
Reactivation Date:

III. Provider practice location address

951 ESSINGTON RD SUITE 400
JOLIET IL
60435-8427
US

IV. Provider business mailing address

790 REMINGTON BLVD
BOLINGBROOK IL
60440-4909
US

V. Phone/Fax

Practice location:
  • Phone: 815-942-8301
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code225X00000X
TaxonomyOccupational Therapist
License Number056-003243
License Number StateIL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: